31 Barriers in the uptake of MRSA ‘search and destroy’ 2 GPs (24%, 29%) indicated to add or refrain from systemic antibiotics where this was not in accordance with the guideline (Supplementary File S2). Discussion The main finding of this study is that there is significant leakage in the cascade of MRSA decolonization care. Firstly, the vast majority of the responding GPs are not familiar with the explicit ‘search and destroy’ policy. Secondly, when evaluating a patient with MRSA carriage, many assumptions are made to refrain from eradication treatment. Thirdly, eradication treatment is not always in accordance with the guideline. The conceptual steps of the cascade of MRSA colonization care are visualized in Figure 1. For optimal effect of the strategy, adherence to each consecutive step is crucial. Based on our findings, the uptake of decolonization care in the Netherlands, as part of the ‘search and destroy’ policy, is not flawless. All subsequent process steps in the cascade have the potential for improvement. We summarized the main leakages of the cascade and the possible solutions in Table 3. The most apparent opportunity for the improvement of its implementation is through expanding familiarity with the ‘search and destroy’ policy. All three steps in the cascade could benefit from the training/education of both the patients and the professionals. In addition, incorporating the policy in the GP practice guidelines should be considered in order to support the entire process from screening to successful eradication. The current national MRSA decolonization guideline is primarily targeted at medical specialists, and the recommendations for screening and treatment have not yet been translated to the Dutch GP guidelines [22]. At the patient level, financial barriers exist that could be targeted by waving the excess fee for MRSA decolonization care. Despite the described leakages in the identification and treatment of MRSA carriership, the MRSA prevalence is low in our country compared to surrounding countries. The estimated nasal colonization rate in the Netherlands was 0.03–0.17% in 2010–2017 [23]. It is generally accepted that this is largely attributed to the ‘search and destroy’ policy [11,24-27]. The policy seems to be effective, despite the leakages we found in the decolonization cascade. The effectivity of the policy as a whole is only partly determined by the uptake of screening and decolonization therapy. Another important arm of the ‘search and destroy’ policy—the preemptive isolation of patients at risk—was not assessed in the current study. There has been debate about the rigorous ‘search and destroy’ policy in the past. Up to the present day, it is the subject of discussion whether healthy carriers that do not have any connections with hospital healthcare should be treated [21]. This is reflected in our results, where the GPs were less inclined to treat a young healthy MRSA carrier compared to an older patient with comorbidity. Although this is a leak in the cascade of care, not
RkJQdWJsaXNoZXIy MTk4NDMw